Cancer medicine journal最新文献

Erb-b2 receptor tyrosine kinase 2 (ERBB2) is a biomarker in the management of breast cancer (BC). Changes of ERBB2 status in primary and synchronous metastasis have been reported in approximately 5% of BC. Here we describe a 55-years-old female with a history of left-side BC and again diagnosed in 2019 with right-side BC tested ER-, PR-, ERBB2+ in breast tissue and triple negative in right axillary lymph node. The right BC and lymph node metastasis samples were tested by chromosomal microarray (CMA); the BC sample harbored more DNA copy number alterations than the lymph node specimen, suggesting that the lymph node metastasis was not directly originating from a dominant tumor clone in the right BC. This case highlights discordant ERBB2 status that can benefit from assessment of ERBB2 in both primary and metastatic specimens. This case also demonstrates the value of using CMA to help understand the clonal evolution of breast cancer metastasis especially when there are discordant biomarker results between primary and metastatic lesions.

Jehovah's Witnesses undergoing liver or pancreas surgery represent a unique medical and ethical challenge. For hepatic and pancreatic malignancies, resections are currently the only curative treatment. These surgeries pose a risk for significant blood loss, for which blood transfusions are traditionally given. However, blood transfusions are considered unacceptable to many Jehovah's Witnesses patients. As the technology of surgery as well as development of new products continue to evolve, transfusion-less surgery modalities have been utilized for Jehovah's Witnesses. The use of these transfusion-less techniques is not yet standardized for hepatic and pancreatic resections. We aimed to review both oncology and transplant medical literature on pancreatic and hepatic resection to develop guidelines for the management Jehovah's Witnesses patients.

Background: Pegfilgrastim is typically administered 24 hours after chemotherapy per package insert; however some patients are unable or unwilling to return for this additional visit due to work or transportation especially with regimens consisting of infusional 5-FU. Same-day dosing eliminates need for this additional visit. Results from prior studies in other tumor types are inconclusive as few support same-day dosing whereas others show inferiority. Purpose of our study was to determine safety and efficacy of administering pegfilgrastim on same day as chemotherapy in patients with gastrointestinal (GI) malignancies.

Method: A single-institution retrospective review was conducted of 69 patients with GI malignancies who received chemotherapy and same-day pegfilgrastim (6 mg) within 1 hour of completion of chemotherapy from Jan 2014 through Jan 2017. As per institutional guidelines, patients were counseled on risks of same-day pegfilgrastim prior to its administration. These patients were compared with a set of 70 patients who received pegfilgrastim 24-hours after completing the chemotherapy for GI cancers.

Result: A total of 536 chemotherapy cycles in 69 patients were analyzed. Median absolute neutrophil count nadir for all cycles was 4538/uL (Range: 1160 - 25168). Grade 1 and 2 neutropenia developed in 6 of 536 (1%) cycles. Bone pain reported in 3 patients (4%). There were no episodes of grade 3 or 4 neutropenia or febrile neutropenia. None had dose reductions, chemotherapy delays, hospitalizations, or antibiotic use due to neutropenia.

Conclusion: We believe our study is the first in GI malignancies to report that same-day pegfilgrastim administration may be as effective and safe as next-day administration, benefiting patients and might reduce costs.

The battle against cancer is formidable even in normal circumstances and the COVID-19 selectively cancer patients with an increased risk of mortality by three times higher than those without cancer but also forced us to shut down the clinical trials in cancer patients to deal with the present crisis. We discuss here the disruptions on research in cancer with its immediate and delayed consequences and offer some suggestions to modify our practices, strategies and rationalization to help succeed the cancer treatment and research after the crisis is over.

Background: Most common sites of metastases in patients with colorectal cancer (CRC) include liver and lung. Brain metastases are very rare but their presence is associated with a poor prognosis and shorter survival. We report our investigation into the impact of race/ethnicity on the incidence of BM in CRC patients.

Method: We retrospectively reviewed patients diagnosed with CRC from 2010 - 2018 at a single institution and analyzed any association of development of brain metastases with race and ethnicity. Race and ethnicity were defined in accordance with federal standards set by the US Census.

Result: We identified 264 CRC patients and 76(29%) were identified as Asian. Of those 76 patients, 5(7%) developed brain metastases. All 5 patients were male and stage IV at initial diagnosis. Brain metastases was a late stage phenomenon. Median time to development of brain metastases was 29 months (Range: 26 - 33). Median overall survival after BM diagnosis was 5.5 months (Range: 4 - 11). Overall survival was longest for the patient who had both radiation and surgery.

Conclusion: Our study showed an incidence of brain metastases of 7% in the Asian sub-population compared to the historical control of 0.6% - 3.2% in the overall population. These results at the least warrant further investigation in a larger patient population of brain metastases in CRC patients with emphasis on molecular markers.

Stereotactic body radiotherapy (SBRT) is an emerging treatment option for patients with pancreatic cancer, as it can provide a therapeutic benefit with significant advantages for patients' quality of life over standard conventional chemoradiation (CRT). The objective of this review is to present alternative clinical settings in which SBRT may benefit patients with pancreatic cancer. These include palliation of pain, elderly patients who are not surgical candidates, local therapy in oligometastatic cases and salvaging local failures after surgery or external beam radiation. We will review these individually and provide supporting literature for each.

Background: Pegfilgrastim is administered 24 hours. after chemotherapy to reduce risks of myelosuppression. This requires an additional clinic visit, which can be difficult for some patients (pts) due to work and transportation issues. In GI malignancies, patients receiving capecitabine-based regimens also require pegfilgrastim to reduce myelotoxicity. We present here the first study to analyze safety and efficacy of administering pegfilgrastim on the same day as capecitabine-based regimens in patients with GI malignancies.

Methods: We evaluated 157 patients with GI malignancies who received a capecitabine-based chemotherapy regimen, including XELOX, EOX, ECX, XELIRI, MIXE, gemcitabine-capecitabine and same-day pegfilgrastim (6 mg) within 1 hr of completion of systemic agents. As per institutional guidelines, patients were counseled on risks of same-day pegfilgrastim prior to its administration. Patients were followed to determine the degree of neutropenia and toxicity.

Results: A total of 914 chemotherapy cycles in 157 patients were analyzed. Median ANC nadir for all cycles was 5634/uL (range: 450 - 23800). Grade 1 and 2 neutropenia developed in 11 of 914 cycles. Bone pain reported in 9 pts. There was 1 episode of grade >3 neutropenia resulting in infection and antibiotic use. No other patient required dose reductions, chemotherapy delays, or hospitalizations. No increased toxicity of capecitabine was noticed.

Conclusions: We believe our study is the first in GI malignancies to report that same-day pegfilgrastim administration with capecitabine-based regimens may be as effective and safe as next-day administration. Additionally, given the absence of CD in human bone marrow, it appears capecitabine can be used concurrently with pegfilgrastim. Prospective studies should be done to further investigate, as this practice can benefit patients clinically, decrease office visits, increase patient's satisfaction and reduce healthcare costs.